Jessica Harper amp Nash Dhalla February 19 2015 Hyatt Regency Vancouver Conflict of Interest Neither presenter Nash Dhalla RN BScN or Jessica Harper RN BScN have any affiliation financial or otherwise with a commercial or other industry interest that may bias our presenta ID: 780461
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Slide1
Community-Driven Tuberculosis Interventions for Aboriginal Communities
Jessica Harper & Nash DhallaFebruary 19, 2015Hyatt Regency Vancouver
Slide2Conflict of Interest:
Neither presenter (Nash Dhalla, RN, BScN or Jessica Harper, RN, BScN) have any affiliation financial or otherwise, with a commercial or other industry interest that may bias our presentation.
Slide3Outline
TBSAC: Who we areWhat is TB?TST vs IGRAFeasibility of Portable Incubator in LTBI testing
Challenges
Next Steps
Slide4TB Services in BC
Centralized: pharmacy, labs, database, physician consultant, and nurse consultant services provided by TB Services, BC Centre for Disease ControlTB Services for Aboriginal Communities (TBSAC): provides TB services to Health Centers located on-reserve, funded and delivered in partnership with First Nations Health Authority (FNHA).4
Slide5TB Services
Community Health NurseCommunity Health WorkerDOT WorkersHealth DirectorsCommunity Members
CDC Coordinator-TB, Funding, Education, Resources
Physician Consultation
Nurse
Consultation
Case Management
Pharmacy, Lab, Diagnostics, X-Ray, Surveillance, Training and Education
Slide6TB Team
BCCDC (TBSAC)Dr. Victoria Cook, TBSAC PhysicianShawna Buchholz, Clinical Nurse EducatorNash Dhalla, Nurse ConsultantKaren Beinhaker
, Nurse ConsultantFNHA, Health ProtectionJessica Harper, CDC Coordinator, TB
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Slide7Background: What is TB?Mycobacterium tuberculosisAirborne disease
Generally infects the lungsIn BC: incidence rate of ~7 per 100 000Symptoms: coughing, fever, weight loss, night sweatsCurable and Preventable!
Slide8Background: What is LTBI?“Sleeping” Latent TB infection (LTBI):
Infected with bacteria? YESSymptoms present? NOInfectious? NOA healthy individual infected with LTBI has a 5-10% risk of developing active TB over their lifetime
(BCCDC TB Control Manual, 2012)
Slide9Background: Diagnosing & Treating LTBI
Tuberculin Skin Test (TST) is an intradermal injection of 0.1ml of purified protein derived from M.Tuberculosis bacteriaFollow up Chest X-ray to check for active TB
Slide10Background: Diagnosing & Treating LTBI
Recommended for preventative therapy:Isoniazid for 9 months –270 doses ORRifampin for 4 months –120 dosesDecision to start treatment is based on:Context of TST – likelihood of false positiveReason client was being testedRisk of progression to active disease
Ability to adhere to medicationPossible intolerance to medicationAlcohol use, desire for pregnancy, etc.
(BCCDC TB Control Manual,
2012
)
Slide11The IGRA TestInterferon Gamma Release Assay (IGRA)Detects interferon gamma released from WBC
Two tests: Quantiferon Gold and T-SpotBC: offered in Vancouver, New Westminster, Victoria, Prince George and Kelowna
Slide12IGRA vs. TST
(TB Manual: Interferon Gamma Release Assay Testing Guideline for Diagnosis of Latent Tuberculosis Infection by Physicians, 2013, pg. 2)
Slide13TST vs. IGRA
TST
IGRA
Good for serial testing
Not as good for serial testing
Inexpensive
More expensive
Universally accessible
Skill,
equipment
and
timeframe needed limit accessibility
Low specificity in certain
populations
(BCG-60%)
High specificity in all populations
Two visits
One visit
Variability in test interpretation by reader
*****
Low variability in test interpretation by reader
Slide14WHY IGRA?
To identify the proportion of patients in whom treatment for LTBI could be avoided because an IGRA test was negative yet a TST test was positive.To determine if there is a statistically significant difference in treatment adherence between BC residents who have had LTBI confirmed with an IGRA test and those whose diagnoses was made using a TST only.
Slide15IGRA Feasibility In First Nations Communities Currently IGRA is offered at the BCCDC, in New Westminster, Victoria, Kelowna and Prince George
Increase access to testing for patients who are less likely/able to travel for testing:Remote communities Outbreak investigationEnhanced communities Identify and treat true LTBIAre communities interested in the IGRA test?
Slide16IGRA testing: Feasibility TBSAC Team & Community Leaders discussed IGRA
Based on enhanced community surveyStrong links with HCPGeographic location IGRA available in Canada 2007 with strong evidence baseBCG FactorCommunity engagement
Slide17Results: Feasibility TestCommunity approval
Meet with BCCDC lab to agree on expectations of how samples are deliveredDevelop detailed protocol on sample collection, processing and transportation to labConfirm site visit date(s)Conduct site visit & feasibility testDetermine resultsSummarizing resultsLessons learned
Slide18Vision of the FNHAIn partnership with BC First Nations Communities the FNHA TBSAC program is working towards the Vision of:
“Healthy, Self-determining and Vibrant BC First Nations Children, Families and Communities.”
Slide19Acknowledgements BCCDC- Zoonotic Lab
Yvonne SimpsonMuhammad MorshedQuantine WongFNHA and TBSAC teamApril MacNaugtonDr. Isaac SobolDr. Victoria Cook Jane LopezMaggie Wong Shawna Buchholz
Karen Beinhaker
First Nations Communities
Healthcare Professionals
Community members
Community leaders
Thank You!
Slide20Contact Information
TBSAC Nurses: Nash Dhalla: (604)707-2695Nash.dhalla@bccdc.caKaren Beinhaker: (604)707-2732karen.beinhaker@bccdc.ca
Shawna Buchholz: (250)878-4928Shawna.buchholz@bccdc.ca
FNHA Nurse:
Jessica Harper: (604)693-6955
jessica.harper@fnha.ca
TBSAC Fax:
(604)707-2690
TBSAC Toll Free:
1-888-569-2299
FNHA Health Protection Toll Free:
1-844-364-2232
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Slide21Thank You!